Care Home: 84 Lawrence Lane

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What the care home does well The home provides a comfortable environment for the accommodation of the service users that presents a domestic ambience whilst providing ample space for resident`s privacy. Staff spoken to showed an interest in their work, a commitment to the ethos of the home and were knowledgeable as to how care should be carried out in accordance with care plans. There was seen to be a good level of training provision, and the manager was aware where further training was needed to build on this so as to develop staff that expressed an interest in providing a good care service. The staff felt well-supported and able to work in an environment where they were well supported by each other and as such able to offer a more stable and consistent service that benefited residents. The interaction we saw between the resident and staff was judged to be of a positive nature. What has improved since the last inspection? What the care home could do better: CARE HOME ADULTS 18-65 84 Lawrence Lane 84 Lawrence Lane Old Hill Cradley Heath West Midlands B64 6EU Lead Inspector Mr Jon Potts Key Unannounced Inspection 7th March 2008 10:00 84 Lawrence Lane DS0000058833.V354304.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address 84 Lawrence Lane DS0000058833.V354304.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. 84 Lawrence Lane DS0000058833.V354304.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 84 Lawrence Lane Address 84 Lawrence Lane Old Hill Cradley Heath West Midlands B64 6EU 01384 633672 01384 410429 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) info@Inshoresupportltd.com Inshore Support Limited Mrs Christine Lake Care Home 3 Category(ies) of Learning disability (3) registration, with number of places 84 Lawrence Lane DS0000058833.V354304.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 1st March 2007 Brief Description of the Service: Lawrence Lane is a three-bedded property situated in an established residential area close to the local amenities and shops offered by the centre of Old Hill. It provides long-term care for up to three younger adults with a learning disability, although only one is currently accommodated. Accommodation briefly comprises of three single bedrooms, bathroom, two lounges and kitchen/diner. The main stated aim of the home is to provide a service that reflects the expectations of the residents: identifying and fulfilling their individual needs by means that are valued by society; this in order to develop and support individual and personal experiences and characteristics which are culturally valued and maintained. There is a staff group that consists of a registered manager, senior support and support workers. There are waking staff available 24 hours per day. The manager is accountable to the company’s responsible individual and directors of Inshore support who have a number of homes of similar size and purpose. The staffing ratio is currently at least one staff member to one resident, although at present is two to one during daytime hours. The charges for accommodation are not currently stated within the homes statement of purpose or service users guide and it was stated that these are were calculated on an individual basis dependent on a pre admission assessment. 84 Lawrence Lane DS0000058833.V354304.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 stars. This means the people that use this service experience good quality outcomes. This unannounced inspection was carried out over one day and involved the inspector assessing the homes performance primarily against the key national minimum standards for younger adults. Evidence was drawn from a number of sources and including case tracking the care for the one individual living at the home (this involving looking at all the documentation in respect of their care and cross checking this with outcomes), observation of practice, discussion with the registered manager, staff and review of management records. We spoke to the resident although it was not possible to discuss their view of the service with them due to communication barriers. Information was supplied pre inspection by the home. The resident, their relative and staff are to be thanked for their assistance with the inspection. What the service does well: What has improved since the last inspection? There has been clear improvement in the service with all the requirements identified at the time of the last inspection fully met. The resident’s care plan was now seen to be completed in sufficient detail so that the strategies the home adopts to meet residents needs in all areas of health, social and emotional care are clear and transparent. Where there are areas that may need review the manager and staff are fully aware of these. The resident now has access to chiropody from health services so as to ensure their foot care is maintained. 84 Lawrence Lane DS0000058833.V354304.R01.S.doc Version 5.2 Page 6 We found the triggers for the administration of ‘as required’ medication to be clearly detailed to ensure that they are only given appropriately, and injections stored by the home are now signed out when given to the community nurse, this so that stock records of such are accurate. A colour pictorial menu is available to assist with stimulating the resident’s choice of foods. Behaviour plans are now accurate in referring to the methods the home uses to manage challenging behaviours so that physical intervention techniques are clear. We also found that records in respect of any use of restraint to be accurate, so that any such incidents can be easily audited. We also saw that there has been redecoration of the home, improving the décor and ambience of the environment. What they could do better: There were a few areas where some improvement was required these as listed below: • • Records relating to any resident’s monies in safekeeping need to be accurate. Development of the service users guide, all key policies and procedures and care records (such as care plans, activity records) in pictorial or alternative formats needs to continue so as to allow easier understanding by the resident. The statement of purpose also needs to include the range of fees that a prospective resident may pay. More care should be taken in respect of records relating to staff recruitment so that they all carry clear evidence of the full working history and references from last social care employer. Induction training for staff in the learning disability award framework should be sourced so that the induction is specific to the aims of the service and resident need. • • Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. 84 Lawrence Lane DS0000058833.V354304.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection 84 Lawrence Lane DS0000058833.V354304.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2 & 5 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Individuals (and their representatives) who are looking to use the service have written information to help them decide if Lawrence Lane will meet their needs. Individuals have their needs and aspirations assessed prior to admission to the home and a statement of terms and conditions (lifestyle agreement) is available on admission. EVIDENCE: The home has not admitted any service users since the time of the last inspection, so the above judgement was based on the knowledge of the management and staff as well as the homes policies, procedures and other documentation that was available to us (such as assessments prior to admission of existing resident). We discussed the admission process with staff and they stated that there was an individual identified that may be considering admission to the home. The senior stated that the process of admission would be gradual to allow the individual time to get to know the staff, home and other resident with staff first going to meet them at their home, following which they would have short visits to the care home building up to an overnight stay. The assessment 84 Lawrence Lane DS0000058833.V354304.R01.S.doc Version 5.2 Page 9 process would carry on concurrently so that when a decision was made both the individual and the service should be aware as to whether Lawrence Lane was able to provide an appropriate service. Staff also stressed that the views of the existing resident needed to be fully considered within this process. We saw that the homes procedures related to admission reflected what we were told. There was clear information available although the development of more pictorial based information and other formats that are more accessible to existing and potential residents would be advantageous. The homes statement of purpose is a specific document to the home based on a generic format used by the companies other homes (which all offer a similar service). It clearly sets out the objectives and philosophy of the home and includes a range of information about the service provided, the accommodation, staffing (experience and qualifications), how to make a complaint and so on. The range of fees for the service for a prospective resident are not stated in the Statement of Purpose or Service User’s guide, these calculated on an individual basis following assessment. It should however be possible to provide an illustration as to a fee range within which the cost of the service would fall. Contracts (called lifestyle agreements) were available to the resident and these set out the basic terms and conditions of the service, although the manager needs to ensure that these are agreed with the residents (where practicable) or their chosen representative, this to be evidenced through such as signature on the document. We saw that there was an accompanying pictorial supplement to the lifestyle agreement available. 84 Lawrence Lane DS0000058833.V354304.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7 & 9 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Individual’s needs are assessed and their needs/goals are reflected in an individual plan. Various methods are used to ensure this plan reflects the individual’s preferences in respect of the care and support they receive. The use of risk assessment supports resident’s independence. EVIDENCE: A detailed care plan for the resident at the home was seen to be in place this covering the full range of needs such as behaviour management, social, health and emotional care, communication and so on. We cross checked the information in the care plan with information in case file such as ‘what is important to you’ that was stated to have been completed on what the individual’s preferences were on a day to day basis. Observation during the day of the visit, discussion with staff, examination of supporting records and comment from the individual’ s relative (who was consulted by staff) all supported the validity of the information in this document and the care plan. It 84 Lawrence Lane DS0000058833.V354304.R01.S.doc Version 5.2 Page 11 was noted that the care plan was not signed by the resident’s representative, although we had confirmation of their involvement. Whilst the care plan is in written format there is some supporting pictorial information in a person centred plan that follows a set format, this containing simpler information in respect of such as important people (with photos) and likes and dislikes. We discussed with staff ways in which they communicated with residents with limited verbal skills and they were conscious of, and demonstrated in observation how this was facilitated, this by such as observing reaction to prompts and using cues to assist the resident with decision making (such as when showing the foods available for lunch and allowing the resident to indicate their preferred choice). Whilst there has been some development of person centred planning and the care plan is written in clear language there is still scope to develop some of the detail of the care plan into easy to understand formats for the individual with an extension of the use of photographs of the activities the resident maybe involved with for instance. There was evidence that this approach is been developed through such as a photo-based menu. Whilst it was not always possible to involve the individual in all aspects of planning the staff use an individual’s expressed dislikes and likes as a basis for the care to be provided in respect of such as when they like to get up, their preferred foods, activities and so on. There was clear evidence that these are reviewed on an on going basis with the involvement of the resident and their representative. The care plans were seen to be supplemented by comprehensive risk assessments. These explore how the home provides a service that is safe without to much compromise to positive outcomes for the residents. Limitations were seen to be clearly documented and agreed with the individual service user’s representative. These do not limit the resident’s scope for developing their independence, with staff we spoke to highlighting ways in which this was done as reflected in records. The home ensures that residents and their representatives are consulted regularly through the homes quality monitoring process to gather information about their satisfaction with the home. This information is gathered centrally and assists with the development and review of the service by management. 84 Lawrence Lane DS0000058833.V354304.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16 & 17 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The individual living at the home is enabled by staff to make choices about their life style, and supported to develop their life skills. The home endeavours to offer social, educational, cultural and recreational activities that meet individual’s expectations. EVIDENCE: We saw and heard that staff at the home assist with the maintenance of important personal and family relationships and the home works in cooperation with relatives, keeping them up to date with developments and listening to what they have to say on behalf of the individual, as was confirmed with the residents relative. Staff also encourage contact with residents from other inshore homes and friendships have developed as a result. The staff have access to information and specialist guidance about issues such as intimate relationships, this also incorporated within company procedures. 84 Lawrence Lane DS0000058833.V354304.R01.S.doc Version 5.2 Page 13 Procedures also consider protection of individuals, and supporting people to make informed choices. Staff we spoke to are aware of the need to pay close attention to the resident’s communication needs and how these manifest themselves, whether verbal or behavioural; with awareness of how this may influence patterns of risk within such as accessing the community to enable full participation in daily living activities. We saw that risk assessments were carried out prior to any activity outside the home – this to identify any potential concerns prior to leaving the house. It was of concern to the manager that there were currently a number of limited number of activities carried out with the resident outside the home, this subject to on-going review. It was clear however that staff offered these activities but let the individual chose whether they participated, this also confirmed by the individual’s relative. Residents, based on records, and observation are involved in daytime activities that accord with their choices, individual interests and capability. Activity plans also showed that there was encouragement for the individual to have involvement in domestic routines such as food preparation, cleaning and laundry. The preferred routines of the resident are clearly detailed and when we asked staff what these were they were clearly aware of them, although they did stress that there was flexibility dependent of individual choice. Whilst the home has its own allocated transport, there was comment that even when the resident wishes to go out the lack of staff that can drive can be a limiting factor. The staff have ascertained the resident’s likes and dislikes based on the foods they choose to eat and the record of foods provided, this showing that the menu is built around these, although is open to flexibility dependent of choices on the day. We saw that verbal communication was limited with the one resident although we saw that food choices were offered by staff. We saw that then resident did not normally have a supper, this said by staff to be their choice, which was of some potential concern as they are diabetic. There was monitoring of sugar levels and records of these, plus no discernable pattern to any behaviour that could be related to low blood sugar levels in the morning period indicated that this was possibly not an issue. Staff were advised to monitor however. We saw that the home now has a colour pictorial menu to supplement the written one on display in the kitchen. The menu was seen to contain foods that reflected the residents likes and dislikes as documented in their case file, this recently reviewed. 84 Lawrence Lane DS0000058833.V354304.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19 & 20 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The health and personal care that people receive is based on their assessment of individual needs and preferences. Appropriate access to community healthcare services for individuals is facilitated and medication managed safely. EVIDENCE: Whilst Lawrence lane is registered for three residents there is currently only one residing there and the service currently focuses on the needs of one individual. The way the individual is to receive personal care and support was set out in some detail in their individual plan and this drew from detailed assessments. In discussion we had with staff they presented as been knowledgeable as to the individuals needs, and observation of staff interaction with the individual was seen to be relaxed. The relative of the individual also stated that they had every confidence in the staff. Personal healthcare needs including specialist health and dietary requirements are clearly recorded in the resident’s individual plan, this including such as 84 Lawrence Lane DS0000058833.V354304.R01.S.doc Version 5.2 Page 15 diabetes which staff in discussion were well aware of, with further evidence of its implementation supported by records. This plan gives a comprehensive overview of health needs and details what input is needed to ensure the individual’s health is maintained. Access to healthcare services is facilitated in accordance with the individual’s planned requirements, with visits to local health care services as needed. The individual who lives at the home is physically able, this meaning there is little present need for adaptation of the premises. The home’s training plan shows areas where the service has identified where staff need training in health care matters and in part this has been complied with, although further training is planned (such as epilepsy awareness and autism). The aims and objectives stress the importance of treating individuals with respect and dignity. The home has an efficient medication policy supported by procedures and practice guidance, which staff understand and follow. Medication records are fully completed, contain all required entries, and are signed by staff. Staff that administer medication have accredited training and are also subject to in house assessment. Regular checks by the manager are undertaken and recorded, these to monitor compliance. It would be useful if the time of the checks were recorded, as the stock would vary dependent on the time this is done. We saw that the home now has a clear protocol for the administration of ‘as required’ medication and there is a clear record of any injections held by the home been signed out by visiting nurses. The home has sought the consent of the resident in respect of administration of medicines and followed this up within a risk assessment framework. The home does not currently handle any controlled drugs. 84 Lawrence Lane DS0000058833.V354304.R01.S.doc Version 5.2 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. People who use the service are able to express their concerns where possible and staff are aware of the need to monitor resident’s behaviour for signs of dissatisfaction. The home has a robust, effective complaints procedure. The service has a good understanding of what constitutes abuse and the correct steps to take should it occur, this to protect residents. EVIDENCE: We saw that the service has a complaints procedure that is up to date, very clearly written, and is easy to understand and is available in written and pictorial formats. The relative of the individual of the home told us they were aware of the homes complaints procedures (with a copy sent with a questionnaire on an annual basis), also stating that that if there was any problem they can ring in and the staff will sort it out. Access of the residents to professionals independent of the service (community nurse, psychiatrists, social workers etc) on a regular basis has been known to provide a means by which concerns can be picked up and addressed. The homes procedure makes it very clear of what can be expected to happen if a complaint is made, although there has been none received over the past year. The policies and procedures regarding protection of individuals are of good quality and are regularly reviewed and updated with a copy of the local authorities easy read adult protection procedures available. The manager and staff are clear when incidents need external input and who to refer the incident 84 Lawrence Lane DS0000058833.V354304.R01.S.doc Version 5.2 Page 17 to. There have been no referrals since the last inspection, this judged to be due to a lack of incidents, rather than a lack of understanding when incidents should be reported. We had sight of evidence to show that staff are subject to enhanced disclosures and POVA (protection of vulnerable adults) list checks as a matter of course, this to verify the safety of staff. Staff were clear that the use of restraint in response to any challenging behaviour is avoided wherever possible, and if this occurs records we saw in respect of incidents are clearly documented. We cross checked these with behaviour plans and found them to concur. The training staff receive is based on the avoidance of restraint (MAPA), all staff having received training in the same. We saw that any incidents of physical intervention had been clearly documented and carried out in accordance with the detailed behaviour plans drawn up by the home. 84 Lawrence Lane DS0000058833.V354304.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 30 Quality in this outcome area is excellent This judgement has been made using available evidence including a visit to this service. The physical design and layout of the home enables the individual who lives there to reside in a safe, well-maintained and comfortable environment, which encourages their independence. EVIDENCE: The provider and manager have ensured that the physical environment of the home provides for the individual requirements of the resident who lives there. The living environment is appropriate for the particular lifestyle and needs of the resident and is homely, clean, safe and comfortable. Areas where redecoration was needed at the time of the last inspection have been addressed and the environment is well presented, light and comfortable. Residents are encouraged to see it as their own home. It is a well maintained, attractive home, which is accessible to local community facilities and services 84 Lawrence Lane DS0000058833.V354304.R01.S.doc Version 5.2 Page 19 in Blackheath. The home also has an allocated car for use by the staff to transport the resident. There was evidence from water temperature records and checking the hot water supply that there is always plenty of hot water and the temperature in the home can be changed to meet their personal choice. The home was very well lit, clean and tidy and smelt fresh. Servicing documentation seen evidenced that the provider ensures the house is safe. The only issue identified was inconsistent fridge temperatures although staff spoken to stated that if checks show that temperatures are to high they turn it down. The management has a proactive infection control policy and staff understand how to manage infection and maintain a safe and clean environment. Risk assessments and items necessary to support infection control were seen to be available (such as liquid soap and paper towels). 84 Lawrence Lane DS0000058833.V354304.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32,34 & 35 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. A diverse staff team are trained, skilled and in sufficient numbers to support the people who use the service, and to support the smooth running of the service, this to allow the necessary consistency of care provision to vulnerable residents. EVIDENCE: The service has a highly developed recruitment procedure that has the needs and protection of people who use the service at its core. The recruitment of good carers was seen by the manager to be integral to the delivery of a good quality service, and she stated that this had created difficulties when trying to recruit good quality staff. We were told by the manager that she is to be given more control of staff recruitment as opposed to staff been interviewed at head office and then allocated to the home. Most elements of recruitment are accurately recorded and the required documentation is usually received prior to the employee starting work, however, there were some omissions in information in the staff file for the last one employed: 84 Lawrence Lane DS0000058833.V354304.R01.S.doc Version 5.2 Page 21 • • There was a gap in the staff member’s working history, the manager however aware of the details missing. She was advised to document this on the file; There were two references but not one from the current last employer, but an ex employee. Reasons for this should be explored and documented. The home has a diverse staff team that has a balance of skills, knowledge and experience sufficient to meet the needs of resident. There is evidence that the staff spoken to demonstrated a good understanding of the particular needs of the individual living at the home. We saw the homes training programme and sampling of copies of training certificates confirmed the accuracy of this. There are areas were some staff require further training although these have been identified by the manager and include epilepsy & autism awareness, this reflecting the needs of the individual living at the home. Staff are currently undertaking training in the implications of the mental capacity act and showed the inspector the workbooks they are using. Staff told us that they were positive about the level of training that was provided to them, and the majority of staff have achieved or are completing a vocational qualification. The manager told us that the company has employed a training officer to better manage training provision and she is due to meet with them to discuss the services training requirements. We saw that the manager sees induction and any probationary period as being an extension of recruitment. There are clear systems in place to ensure that there is closer supervision of new staff and the knowledge aspect of induction training is provided by the company through external training provision, although it was stated this does not include LDAF (learning disability award framework), this as there was difficulty sourcing this at present. We spoke to staff who stated that they received sufficient one to one supervision from the manager and records we saw also confirmed this was the case, especially for new employees. We saw that the interview and selection process is based upon identified criteria that are closely related to the specific job and supports the procedure. The resident is not directly involved in the recruitment process for what we were told are valid reasons although there is opportunity for prospective staff to visit the home and meet the resident prior to employment. Staffing levels reflect the needs of the residents, and rotas are flexible to fit around the lifestyles of individuals and specific activities. 84 Lawrence Lane DS0000058833.V354304.R01.S.doc Version 5.2 Page 22 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39,41 & 42 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The management of the home is based on openness and respect and has an effective quality assurance system developed by the homes senior management. Where there is room for improvement this is acknowledged and accepted by management that express a wish to excel. EVIDENCE: Christine Lake, the registered manager has managed the home for well over a year now and in that time has clearly made improvements to the service at Lawrence Lane. Discussion we had with some of the staff indicated that they were positive about the support given to them by the manager and we heard from the resident’s relative that they were confident in the manager’s abilities as well as that of the provider. The manager also informed us that she has now 84 Lawrence Lane DS0000058833.V354304.R01.S.doc Version 5.2 Page 23 completed her management qualification and is awaiting her certificate to confirm the same. The responsible individual for the company provides supervision for the manager and we receive copies of reports completed by them on a regular basis, this confirming that the provider has suitable methods for monitoring the quality of the service. The service, based on the recently revised business plan we saw is planned to be user focused, and generally works in partnership with other professionals. The home has policies and procedures that set out the aims and objectives of the service, with staff having copies of key polices provided to them within a staff handbook. Staff were well aware of the home’s policies in discussion with us. The home uses questionnaires for stakeholders and staff and the manager has regular contact with the individual living at the home. Staff meetings were said to be held at least quarterly, although there were only minutes of the last one, held this year. The manager was clear as to the need to ensure these are documented. The manager is involved with a suitable quality monitoring system that she completes in conjunction with the responsible individual, this system measuring the homes performance against national minimum standards and legislation. Whilst the AQAA (annual quality assurance assessment) submitted to the CSCI could have been better it is known that the responsible individual has sourced training for managers within the company in respect of how these annual quality assurance assessments are completed. The data section of the AQAA is accurately and fully completed however. We saw that records relating to the monies in safekeeping are of good order although there was an error, as the amount seen did not balance with said records. The manager was advised that she must ensure these records are accurate. We saw robust procedures in respect of the protection of resident’s valuables, these supported by risk assessments. In addition inventories of all the individual’s property was seen to be present. The home works to a clear health and safety policy and in discussion the manager and staff were fully aware of this and had also received training that helped them put theory into practice. We saw the last Environmental Health Officer’s report from their visit to the home in October 2007 and areas identified would seem to have been addressed (with the exception of inconsistent fridge temperatures). They stated in respect of the home’s health and safety policy that it was comprehensive and no items were noted as being of concern at the time of the inspection. 84 Lawrence Lane DS0000058833.V354304.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 X 4 X 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 4 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 2 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X 2 3 X 84 Lawrence Lane DS0000058833.V354304.R01.S.doc Version 5.2 Page 25 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA42 Regulation 17 Requirement The Registered Manager must ensure that the records relating to any resident’s monies in safekeeping are accurate. Timescale for action 15/04/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA1 Good Practice Recommendations The Registered Persons should develop all key policies and procedures (such as the service users guide) and care records (such as care plans, activity records) in pictorial or alternative formats that allow easier understanding by the residents. The Registered Provider should ensure that the range of fees that a prospective resident may pay are detailed within the home’ s service user guide or statement of purpose. The Registered Persons should ensure more care is taken in respect of records relating to staff recruitment so that they all carry clear evidence of the full working history and references from last social care employer. The Registered Provider should source induction training that has links to the learning disability award framework. DS0000058833.V354304.R01.S.doc Version 5.2 Page 26 2. YA1 3. YA34 4. YA35 84 Lawrence Lane Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI 84 Lawrence Lane DS0000058833.V354304.R01.S.doc Version 5.2 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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